"The plaintiff is challenging the Iowa law requiring that, among other provisions, 'any willing pharmacy' be included in a prescription drug plan's provider network, including self-insured prescription drug plans governed by ERISA. In October, a federal judge blocked enforcement of several portions of the law, citing potential conflict with ERISA. In its brief, ERIC argued that ERISA preempts Iowa's law because that law directly interferes with prescription-drug benefit plan design and administration [.]" [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025; on appeal to 8th Cir. No. 25-2494)] MORE >>
"The ERISA Industry Committee (ERIC) and allied organizations filed an amicus brief in the U.S. Court of Appeals for the Eighth Circuit ... The lower court had ruled that certain provisions of a new Iowa state law -- Senate File 383 -- regulating [PBMs] are preempted by [ERISA], but that other provisions of the law were not preempted. In its brief with the Eighth Circuit, ERIC asked the court to affirm the lower court's decision in part and to reverse it in part to provide that all of Senate File 383 is preempted by ERISA." [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025; on appeal to 8th Cir. No. 25-2494)] MORE >>
"Initially, the Court declined to certify the class on adequacy and commonality grounds. On a renewed motion, however, the Court found there was evidence that enough individuals had actually paid balance bills to satisfy numerosity and that the key questions in the case predominated over individual differences, making class certification appropriate." [L.D. v. United Behavioral Health, No. 20-2254 (N.D. Cal. Oct. 3, 2025)] MORE >>
"Judge Glenn Suddaby of the U.S. District Court for the Northern District of New York in Syracuse declined a dismissal motion for governmental immunity by the Nation's hospitality and gaming company ... Suddaby's ruling on [ERISA] lawsuit, brought in December 2024 by three former police officers, said he wouldn't dismiss the case against the company's benefits plan and investment committee, because the retirement plan also covers non-government casino employees who represent most of the plan participants." [Jones v. Turning Stone Enterprises LLC, No. 24-1596 (N.D.N.Y. Dec. 9, 2025)] MORE >>
"The panel's brief decision underscores that the Court's 2024 decision in Bristol Holdings applies broadly to state-law causes of action arising from pre-service verification-of-benefits and authorization communications, even where a provider also pleads an alternative ERISA benefits claim pursuant to an assignment of benefits from the member. ... [T]he disposition is a clear, persuasive affirmation of Bristol's reach." [Dedicato Treatment Center, Inc. v. Aetna Life Ins. Co., No. 26-6487 (9th Cir. Nov. 24, 2025; unpub.)] MORE >>
"This decision reinforces the Ninth Circuit's now-settled view post-Bristol: state-law misrepresentation and estoppel theories aimed at securing ERISA plan benefits are preempted, particularly when based on preauthorization or verification calls. Providers seeking payment disputes must proceed, if at all, under ERISA's civil-enforcement framework -- not state-law theories of reliance or oral promises." [Healthcare Ally Mgmt. of Calif., LLC v. United Healthcare Services, Inc., No. 24-5178 (9th Cir. Dec. 4, 2025; unpub.)] MORE >>
"The panel's brief decision underscores that the Court's 2024 decision in Bristol Holdings (discussed here) applies broadly to state-law causes of action arising from pre-service verification-of-benefits and authorization communications, even where a provider also pleads an alternative ERISA benefits claim pursuant to an assignment of benefits from the member." [Dedicato Treatment Center, Inc. v. Aetna Life Ins. Co., No. 26-6487 (9th Cir. Nov. 24, 2025; unpub.)] MORE >>
"Although the plaintiff pleaded only state-law claims -- including fraud, negligent misrepresentation, conversion, unjust enrichment, and civil conspiracy -- the court held that ERISA's 'extraordinary pre-emptive power' converted those claims into federal claims under ERISA Section 502(a). Because the plaintiff already had a parallel ERISA action pending over the same conduct, the court allowed dismissal of the duplicative suit." [Patterson v. UnitedHealth Group, Inc., No. 25-3175 (6th Cir. Dec. 2, 2025)] MORE >>
"The plans argued that since Rule 128 places a direct obligation on ERISA-governed plans in the form of reporting and dispensing fee requirements, ERISA preempts it. ... The court noted that the rule applies to all plans, not just plans that fall under ERISA.... One critic of the decision pointed out that Rule 128 expressly refers to self-funded plans and establishes reporting requirements similar to the PBM rule that the Supreme Court found to be preempted by ERISA in Gobeille[.]" [Central States, Southeast and Southwest Areas Health and Welfare Fund v. McClain, No. 25-3938 (N.D. Ill. Sep. 2, 2025)] MORE >>
"Despite Rule 128's express reference to self-funded plans and imposition of a reporting requirement similar to one the Supreme Court found to be preempted by ERISA in Gobeille, the district court found that neither the reporting requirement nor the dispensing fee requirement were preempted by ERISA." [Central States, Southeast and Southwest Areas Health and Welfare Fund v. McClain, No. 25-3938 (N.D. Ill. Sep. 2, 2025)] MORE >>
"[The District Court] granted a preliminary injunction preventing beneficiaries from pursuing claims in the Cheyenne River Sioux Tribal Court over disputed life insurance proceeds. The court held that because the benefits arose under an ERISA-governed plan, federal jurisdiction was exclusive and tribal courts lacked authority to adjudicate the dispute." [Metropolitan Life Ins. Co. v. Mundahl, No. 24-3029 (D.S.D. Sep. 19, 2025)] MORE >>
"In yet another case in the continuing trend of ERISA preemption challenges to state laws regulating PBMs, this decision aligns very closely with Rutledge, but the outcome of these cases depends on specifics -- state laws directly affecting ERISA plan design are more likely to be held preempted." [Cent. States, Se. & Sw. Areas Health & Welfare Fund v. McClain, No. 25-3938 (N.D. Ill. Sept. 2, 2025)] MORE >>
"[In] the Department's view, the mere fact that the terms of the program contemplate limited situations where an award could be paid after termination of employment does not implicate a deferral of income of the kind contemplated by ERISA section 3(2)(A). Thus, the Department has no reason to believe that the deferred incentive compensation program is an employee benefit pension plan under ERISA section 3(2)(A) as a result of such surrounding circumstances." MORE >>
"Shortly before a reduction in force took effect, an employee was terminated for cause and informed that she was not eligible for benefits under the employer's ERISA-covered severance pay plan. Rather than file an appeal under the plan's claims procedures, the employee sued under state law ... [T]he First Circuit concluded that the employee had merely attempted an 'end run' around ERISA with allegations that she relied on misleading statements when not claiming benefits under plan procedures. But ERISA provides the exclusive cause of action in precisely such circumstances." [Orabona v. Santander Bank, N.A., No. 24-1905 (1st Cir. Jun. 16, 2025)] MORE >>
"The plan challenged an Arkansas rule issued under a state [PBM] licensure act and intended to ensure 'fair and reasonable' pharmacy reimbursements and adequate pharmacy networks.... [T]he rule permits the Arkansas insurance commissioner to review the adequacy of pharmacy reimbursement payments made by health plan PBMs.... [T]he court concluded that the plan failed to sufficiently allege that the rule referred to, or had an impermissible connection with, ERISA plans, and therefore dismissed the action." [Cent. States, Se. & Sw. Areas Health & Welfare Fund v. McClain, No. 25-3938 (N.D. Ill. Sept. 2, 2025)] MORE >>
"[T]he plaintiff is challenging a Tennessee law requiring that 'any willing pharmacy' be included in a prescription drug plan's provider network, including self-insured prescription drug plans governed by ERISA.... [The amicus brief] explains that ERISA preempts the Tennessee law because that law directly interferes with prescription-drug benefit plan design and administration by: [1] Restricting plan sponsors' ability to design pharmacy networks for their plans; and [2] Limiting the ability of plan sponsors to implement effective cost-savings measures for their plans." [McKee Foods Corporation v. BFP Inc., No. 21-0279 (E.D. Tenn. Mar. 31, 2025; on appeal to 6th Cir.)] MORE >>
"Although this order likely postpones Act 624’s effective date, a preliminary injunction is just that: preliminary. The court’s reasoning for the commerce clause and supremacy clause challenges rests entirely on a preliminary assessment of existing law. But since those challenges are now moving to litigation, both parties must now present evidence for their claims, along with additional legal arguments, which will inform the final decision on Act 624 at trial." [Express Scripts, Inc. v. Arkansas State Board of Pharmacy, No. 25-0520, 25-0524 (E.D. Ark. Jul. 28, 2025)] MORE >>
"The 10th Circuit's position stands for now ... It will have a ripple effect on other states even though it is the law only for states within the 10th Circuit. Presumably, it means that ERISA does not preempt state rate/pricing mechanisms, but ERISA does preempt state level regulation of plan design or coverage requirements." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. denied Jun. 30, 2025, No. 23-1213] MORE >>
"[The Court] enjoined the provision mandating the inclusion of specific contract terms between PBMs and third-party payors, finding it interferes with fiduciary discretion under ERISA.... The provision requiring all beneficiary payments to count toward a participant's deductible was enjoined. The Court held this mandate directly regulates cost-sharing structures, a core element of ERISA plan design ... [T]he court's detailed and methodical opinion ... offers a robust framework for evaluating the intersection of state PBM laws with federal ERISA and First Amendment protections, and may serve as a persuasive guidepost for other courts reviewing similar legislation across the country. " [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025)] MORE >>
"With respect to the fact that top hat plans are exempt from ERISA's fiduciary duties, the court said 'The statutory regime shows that Congress 'deliberately omitted' these duties because high-level employees can protect themselves through contract.... The preemption provision thus continues to apply to these plans even though ERISA exempts them from many rules.' " [Aldridge v. Regions Bank, No. 24-5603 (6th Cir. Jul. 17, 2025)] MORE >>
"By denying review of the Mulready decision, the Supreme Court fostered uncertainty that is resulting in nationwide ramifications.... [A]dvocates against PBM regulation have already challenged PBM laws in Minnesota, Tennessee, Iowa, Oklahoma and Arkansas ... Similar to Rutledge, the outcome of these lawsuits will have significant ripple effects across the country and may influence broader discussions in Congress." MORE >>
"The Sixth Circuit was called upon to answer two questions: [1] whether ERISA preempts the managers' state law contract-based claims; and [2] whether ERISA Section 502(a)(3) ... allows them to seek the value of their lost claims in the form of equitable surcharge. It answered yes to the former question and no to the latter." [Aldridge v. Regions Bank, No. 24-5603 (6th Cir. Jul. 17, 2025)] MORE >>
"A recent First Circuit decision ... illustrates how ERISA preemption of state law protects employers where a former employee asserts state law claims alleging improper termination of employment to avoid paying severance benefits. This post describes the benefits of ERISA preemption, provides an overview of the First Circuit decision, and highlights key aspects courts look to in determining whether a severance program is an ERISA plan." [Orabona v. Santander Bank, N.A., No. 24-1905 (1st Cir. Jun. 16, 2025)] MORE >>
"[E]ven though ERISA exempts top-hat plans from fiduciary duties, it still preempts state-law claims that impose alternative standards of conduct or remedies.... Plaintiffs cannot use Section 1132(a)(3) to seek monetary relief for plan losses, regardless of whether they style the remedy as 'surcharge' or 'equitable compensation.' The court reaffirmed a narrow reading of 'equitable relief.' " [Aldridge v. Regions Bank, No. 24-5603 (6th Cir. Jul. 17, 2025)] MORE >>
"The decision to leave Mulready as-is re-enforces ERISA preemption and the corresponding limitations of a state's ability to impact employer-sponsored health plans. However, while this decision preserves an ERISA plan sponsor's control over benefit design and network structure, states will likely continue their pursuit of PBM legislation and regulation." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. denied Jun. 30, 2025, No. 23-1213] MORE >>
